In a scary update to an already scary story, the New York state Department of Health is warning any man in the state who had sex in the last six months with a man from New York City to immediately get vaccinated against a particularly deadly variant of meningitis. (The warning is, sadly, a bit confusing – read on.)

A recent article in in the NYT notes that while typically meningitis kills one in five people it strikes, this strain kills one in three.

Last fall, the recommendation to vaccinate was limited to non-monogamous gay men who lived in NYC and were HIV-positive, or who were HIV-negative and lived in specific areas of Brooklyn.

And now, it’s been expanded even further to include any man who has visited NYC since September 1, 2012 and had sex with another man while there. There’s also a vague line about gay men who are HIV-positive, but it’s not clear from the way the warning is written whether even HIV-positive men who visited NYC and didn’t have sex while there should get a shot.

First off, take these warnings seriously. I plan on getting my shot this week, even though I live in DC. As a doctor recently told me when I asked him about whether I should get a shot: It’s better than dying. (Note that insurance may not cover it.)

Here’s a bit on the symptoms from NY Department of Health:

Meningococcal disease is a severe bacterial infection of the bloodstream. Common symptoms include high fever, headache, vomiting, stiff neck, and a rash. Symptoms may occur two to 10 days after exposure, but usually within five days.

Other things I’ve read have said that people have been found dead before they even had a chance to go to a doctor.

I think I have to say a word about the poor manner in which these warnings are written. I’m a lawyer and it’s taken me fifteen minutes to understand exactly what the new recommendation is actually saying, and honestly, parts of it still don’t make sense, like the part about HIV-positive gay men.

For example, the warning says “all HIV-infected MSM” living in NYC should be vaccinated. MSM is a term of art meaning “men who have sex with men.” It’s a way of covering men who don’t think they’re gay, but still sleep with men. So they’re saying that if you’re HIV+ and you stepped foot in NYC since last September, and even if you didn’t have sex, you should still get a shot? Judging by the fact they talk about non-monogamous HIV-negative men in the next bullet, the clear suggestion is that it doesn’t matter if you’re celibate, if you’re HIV-positive you need the shot. But it’s not clear.

The language about those who are HIV-negative is just as confusing. Let me first quote it:

MSM, regardless of HIV status, who regularly have close or intimate sexual contact with men met through an online website, digital application (“app”), or at a bar or party. (Previously, meningococcal vaccination was recommended only for those with contact in certain high risk areas in New York City)

Define “regularly”? I’m quite serious. I have no idea what “regularly” means – a few times a week, a few times a month, or what?

And what is “close” contact? Again, I have no idea what that word even means – is a hug close contact? Is hanging out every day with someone, “close contact”? Is living with them, even if you’re not sleeping with them? Sharing a tooth brush? What about a sneeze? I dunno. And if you have sex, does it matter what kind of sex, or is anything risky with someone who’s infected? Warning doesn’t say.

Then there’s the weird line: “met through an online website, digital application (“app”), or at a bar or party” that these warnings keep using. That’s awfully specific. I suspect many of the cases must have been contracted from men met either online, or at a bar or party – thus the warning. The problem is that the warning is an “i.e.” rather than an “e.g.” Meaning, the way it’s currently phrased says you should only get a shot if you met someone online, at a bar or a party. If you met them any other way, it’s okay, no shot is needed – or is it? Are closeted guys going to gay parties and gay bars? I doubt it. As for the Internet, probably more likely, but still. They might be going to prostitutes, bathhouses (which aren’t bars or parties), forests, or lots of other locales where you might look for love if you’re not openly gay, or even if you are. Is that what they meant to say – that only if you met someone at one of those specific venues should you get a shot?

And what about the rest of us. Lots of guys in DC visit NYC. In the past six months, what if one of those guys comes back here and sleeps with someone in DC. The rest of us here shouldn’t get shots too? I realize the NY State Department of Health doesn’t have jurisdiction in DC, but their warning does talk about men in the rest of the state of NY:

The recommendation by DOH has been expanded to include MSM residing outside NYC who have traveled to the City and engaged in the risk behaviors described below since September 1, 2012.

What if a guy living in Albany sleeps with someone who had relations with someone in NYC since last September? That’s not a problem? Under the way this is written, it’s not.

Lives are at stake, and it might be nice for public health people to stop writing documents in the lingo of other public health people, and start writing them for human beings. You shouldn’t need a law degree — strike that, a law degree isn’t helping — a public health degree in order to understand whether your life is potentially in danger.

Honestly, at this point, as we’re talking about something that can easily cross state boundaries through the visit of one man to New York City, we ought to be getting more clarification from the CDC and HHS. I’ll be asking the administration for more guidance on this on Monday.

John AravosisFollow me on Twitter: @aravosis | @americablog | @americabloggay | Facebook | Instagram | Google+ | LinkedIn. John Aravosis is the Executive Editor of AMERICAblog, which he founded in 2004. He has a joint law degree (JD) and masters in Foreign Service from Georgetown; and has worked in the US Senate, World Bank, Children's Defense Fund, the United Nations Development Programme, and as a stringer for the Economist. He is a frequent TV pundit, having appeared on the O'Reilly Factor, Hardball, World News Tonight, Nightline, AM Joy & Reliable Sources, among others. John lives in New York City, and is the cofounder of TimeToResign.com. Bio, article archive.

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But thus far, the disease, for reasons the health department can’t explain, has remained solely in the gay and bisexual community. “We don’t actually know why it’s only occurring in men who have sex with men,” says Dr. Jay Varma, deputy commissioner for disease control at the health department. “If you look at the subset that is this population, it is occurring at a rate 20 times higher than the overall population and 40 times higher than men who aren’t gay or bisexual. It’s frightening. We’re fearful that if we don’t stop it, it’s going to get worse.”

BronxKid60

“But thus far, the disease, for reasons the health department can’t explain, has remained solely in the gay and bisexual community. “We don’t actually know why it’s only occurring in men who have sex with men,” says Dr. Jay Varma, deputy commissioner for disease control at the health department. “If you look at the subset that is this population, it is occurring at a rate 20 times higher than the overall population and 40 times higher than men who aren’t gay or bisexual. It’s frightening. We’re fearful that if we don’t stop it, it’s going to get worse.”

BronxKid60

Has the Center for Disease Control alerted the schools to protect the children? This strain is spread through saliva.

i don’t think it’s necessary to go there, and the vaccinations takes 3 days to take effect, according to the DOCTOR I got mine from. you two are just spreading the very paranoia and fear you’re blaming the medical community for. for shame

gfd6754

As if this is news. Gays have been at the top of the disease list for decades. They continue to spread illness far and wide more than any other group in the world. Go figure.

tamarz

As a public health person, I also think their description is confusing. They must not have people who actually know how to communicate in the office that produced these warnings. This isn’t a public health jargon issue, just poor communication skills.
I think you’re absolutely right to get the vaccine. I’ve had the vaccine as has everyone in my family. And that’s even though I haven’t had sex with a man from (or in) NYC in at least 35 years, nor has my husband, nor has my older daughter who doesn’t have sex with men anyway, nor has my younger daughter who is (thank god) not yet sexually active.

Travelassie

Perhaps you’d be good enough to cite your references for those claims…..

Travelassie

Is that a serious question? Because the N. meningititis bug takes up its residence in the respiratory passages ( ie, oropharynx, nasal, sinus passages, and it’s spread by respiratory droplets.. It’s more likely to be spread through activities in which one wouldn’t think to use a condom. Or even if one was wearing a condom, one could still get this bug through kissing, or inhalation of respiratory droplets ( being too close to someone when they sneeze or cough.

sayencrowolf

It’s confirmed that ADAP will pay for the shot for those that are enrolled. Providers are instructed to code it as they would any other inoculation.

Those not on ADAP or using their own insurance? I’d expect that answer would vary as much as anything. My own insurance is a $10 copay per visit, period – and I know I’m one of the lucky ones.

I have to believe that if someone were to walk into a dispensing location and claim financial distress that some accomodations are being made. When it’s a choice between potentially saving someone’s life, and kicking them out of the door to a health issue/possible death the right way to act is obvious.

FunMe

You’re nuts! Straight people have sex in cars all over the country, in elevators, and many other areas that I would not even think about having sex in. Why just recently, some straight men in high school raped a girl who was passed out. That is only one of hundreds of instances of straight people engaging in “dangerous sexual behavior”.

Go peddle your homophobia somewhere else. And while you’re at it, go jump into a lake and don’t come back.

victoriousreality

This article is a textbook example of why
homosexuality is dangerous. I’ll take
selected quotes from John’s article with specific questions.

“I plan on getting my shot this week, even though I live in DC.”

Why? Do you plan on having sex with people that may have other unknown partners?

“… the clear suggestion is that it doesn’t matter if you’re celibate, if you’re HIV-positive you need the shot…”

You don’t need to be celibate – just in a trusting, monogamous relationship. There are numerous STDs in the heterosexual community, and none of them concern me one bit, as I am in a monogamous heterosexual relationship and I will never have to worry in my life about STDs.

“Define “regularly”? I’m quite serious. I have no idea what “regularly” means – a few times a week, a few times a month, or what?”

How about never? Why all the casual sexual hookups?

“Are closeted guys going to gay parties and gay bars? I doubt it. As for the Internet, probably more likely, but still. They might be going to prostitutes, bathhouses (which aren’t bars or parties), forests, or lots of other locales where you might look for love if you’re not openly gay, or even if you are. Is that what they meant to say – that only if you met someone at one of those specific venues should you get a shot?”

Do gay men ever go to bars just to have a drink? Or to the forest just to hike? What’s with all the seeking out of casual sex? Seriously? (I asked this of a close friend of mind, who
is gay. I’ve known him for 30 years. And for 30 years he’s been seeking casual sexual hookups. He said it’s just what gay men do.)

“:And what about the rest of us. Lots of guys in DC visit NYC. In the past six months, what if one of those guys comes back here and sleeps with someone in DC. The rest of us here shouldn’t get shots too?”

Yea, I guess you need a shot if you plan on having casual sex with questionable partners.

I noticed that nowhere in John’s article does he advocate life-long monogamous relationships (which you would think he would advocate, since he pushes for same-sex marriage). On the
contrary, he implies that frequent, anonymous, or near-anonymous sex happens, and with frequency.

There is only one conclusion to reach from his own words: gay men engage in dangerous sexual behavior in a way that is far more central to their life, than exists in the heterosexual community.

FunMe

Oh my gosh, scary! Hoping our gay brothers are being careful. Does that mean that even if you use a condom there is a risk?

Zorba

Exactly.
The thing that also worries me is that this will be one more reason for the Christo-fascists in this country to trash gay men. Pardon me, but bacteria and viruses don’t give a royal rat’s ass what gender, sexual orientation, or whatever, you are.
HIV-AIDS in sub-Saharan Africa, for instance, has always been by far mainly a heterosexually-transmitted disease. In the past, at least in this country, many, if not most, people did not realize this. And I bet if you ask the ignorant masses in the US, you would still have a whole lot of people thinking that AIDS is a “gay disease.”
Pathogens don’t discriminate.

I know. And as David Phillips points out above, vaccinations usually take weeks before they achieve full effectiveness.

Zorba

It is only a matter of time before this strain spreads, Becca.

Zorba

I’m sorry about your friend, Indigo. But you are absolutely correct. Our dentist (who takes a careful look at his patients’ mouths, not just their teeth) told Mr. Zorba (who is a molecular biologist) that he has referred more than a few patients to their physicians in recent years, because of suspicious-looking lesions in their mouths. Some turned out to have oral cancer caused by HPV. We are talking women as well as men, BTW.

Meanwhile, in other LGBT-related news, in an interview today, known pedophile-enabler Cardinal Dolan says that gay people are only “entitled to friendship”, continues to trot out the illogical canard that marriage is only for breeders, and laughingly expects us to believe him when he says that none of his beliefs are motivated by the fact he hates gay people for purely religious reasons.

Yeah, the comms from NYC DOH are a hot mess, but you’ve got to wonder about the response of LGBT health organizations, particularly those on the East Coast in recent weeks. Vaccinations produce immunity in weeks, not at the prick of a needle; yet, we’ve had LGBT health groups merely suggesting that current clients could request the vax, instead of pulling out the stops for community-wide vax through all possible providers.

P.S. Let’s cut the crap about HIV jumping from Gay men to heterosexuals. Hundreds of thousands of heterosexual Africans and Caribbeans died from HIV over the century before the CDC’s 1981 report on clusters of opportunistic infections among Gay men.

You could very well be right. On the other hand, if or when this spreads to the general public, the question is going to be asked, “Why didn’t you warn everyone? Since meningitis is not an STD, what warranted keeping the warnings only to the gay male “hook-up” community?”

Indigo

I have a friend who passed away from HPV cancer of the throat a few years ago. It’s a real danger and can be spread through oral sex. No kidding!

sayencrowolf

These notifications are also email blasted to health officials throughout the state, so that puts the burden of interpretation on the providers whether it’s your regular MD or the counselor who’s having the chat with you prior to your HIV test you’re getting for free at the clinic. No doubt that every one of them is boiling down the language to an ultra-simple distillation: if you’re sexually active – get the shot. If you’re MSM and just plain ol’ worried about it – get the shot. I doubt very seriously that anyone is going to be risk-assessed just to get the shot. If you walk in the door of a dispensing clinic, that’s the largest hurdle to jump.

I’ve read reams of these notifications and they are never, ever worded simply – unfortunately – and I doubt they will be. Look at one of the first MMWR’s on AIDS – http://www.cdc.gov/mmwr/preview/mmwrhtml/june_5.htm. It’s about as simple as reading tax instructions and just as clear

Yep, I’d mentioned before about the HPV vaccine, I got mine – even though it’s not cheap, it’s like $180 a shot and you need three shots (of course, it’s slightly cheaper in Europe, but not by a ton). And yes, the recommendations on the HPV vaccine for gay man are kind of vague IMHO. Then, when I talked to an expert about it, I was told that if they were me, at my age, as a single gay man, they’d get the shot, and they themselves did.

Well, I suspect they’re conflating the two because that’s where the cases are. What worries me is that all you need is one MSM to try a little MSW and the thing spreads to women and thus heterosexually. But, as the commenter noted above, maybe they didn’t want to start a panic and swarm to get the vaccine. I dunno.

All of that helps. But what I found was, the notice makes sense until you try to explain it to someone, then you realize it’s riddled with holes. I assume it covers any sexually active msm who is non-monogamous or sleeps with someone else who is non-monogamous, and I’d also assume that if there’s any chance you’re sleeping with someone who slept with someone from NYC since last Sept, you should also get the shot. But what about someone who slept with someone who slept with someone – even there, I’d get the shot.

sayencrowolf

It’s not rocket science:

**More than half the contracted cases so far have been HIV positive, a possible risk factor of this new mutation (I’ll say it if they won’t), indicating that HIV+ men, healthy or not are being impacted by this. It works so fast that most are dead before they even realize that they need a hospital.

**MSM isn’t a “term of art”, it’s a HIV statistical group designation from the CDC to transcend the labels most guys hinge themselves on. I know plenty of guys who’ll call themselves straight, but occasionally get something on the side from another guy. Without MSM, the list of groups would be endless.

**Hooking up online isn’t always about penetrative sex. What’s to say two guys don’t hook up, make out and settle for a good ol’ reach around? Close enough contact for a possible exposure so bingo – that’s covered too for a risk group.

**Of all the patients who’s sexual habits have been discovered in questioning, all of indicated that they’ve hooked up through an app like Grinder, Growlr, A4A. Who’s to say that John Doe doesn’t get a little play on Growlr on Friday, and then meets a hottie at the bar on Saturday? Not out of the realm of possibility so if he is exposed he’s passed it to two guys, two different ways. Hence the warning and they now have the attention of guys who might not hook up online, but will go after their play at the bar. These are the guys of highest risk, direct quote from the notification. That’s not to say that other guys aren’t at risk at all.

**They can’t say “epidemic” or “all MSM should get the shot” because what would happen if they did? There’d be a stampede to dispensing clinics and demand would far exceed supply and panic would run rampant. 22 cases and 13 dead is enough to scare the crap out of officials, but far from enough to sound the “oh, crap” alarm.

This particular strain has been around since 2010, at it’s growing. Quickly. It’s deadly serious and guys who get their action in NY and aren’t getting the shot are toying with their lives. Dispensing sites are ALL over the city, and it’s probably covered under Ryan White/ADAP for those HIV+ who are enrolled. Those who carry their own insurance are probably on the hook if they use their own MD. I haven’t heard a word if the dispensing sites charge, and if so how much.

This doesn’t need to be overanalyzed. Remember, AIDS started out as just a few gay men who got sick and died.

Straightnotnarrow

^^^ This. From what I’ve read about the outbreak I do not understand why the recommendations are so specific as this organism has no particular prediliction for MSM. It’s wierd.

silvermaran

It would be nice for a change to get some truth out of so much corruption. Like telling the people they infected us all with gene sharing stealth spirochetal prion protein infections in vaccine for over 35yr.s that don’t care what it shares its genes with to survive. They lie like dogs because they had much rather add to the mix and kill you faster than use our money to fix us.http://www.youtube.com/watch?v=LRQ-NhEkLXU&feature=youtu.be
You can kill all the infections in the Real AIDS and then your own stem cells will keep them out and STOP the pandemic of syndromes. But first they have to tell you what really causes Meningitis and the syndromes instead of depressing your immune systems more with more junk.http://www.youtube.com/watch?feature=player_embedded&v=yOno_2m_8LY

1. Meningitis is spread through mucosal contact — which means, yes, kissing, unwashed hands that have rubbed a nose, picking up someone’s used kleenex, you name it. I have NO clue why they’re conflating this outbreak with gay male sex or why they are limiting the warning to just that group. Geographic area, that kinda makes sense, but this warning makes it sound like the only people gay men ever have contact with are other gay men, and that’s ridiculous.

2. Gay, straight, male, female, I should think that anyone with a reasonably active social life, whether or not it includes sex with strangers, and who happen to live near NYC or travel to it frequently should get the vaccine. Right?

If this is a new form of meningitis that is primarily an STD — which would represent a significant mutation — and not spread the way most meningitis is spread, the NY health dept and CDC should say so. This crazy incremental fear-mongering and inadvertent (?) gay-baiting isn’t helping.

AnitaMann

Exactly. “Close” contact? What does that mean? How is that restricted to gay men?

MichaelS

This whole thing smells rotten… like the Health Dept. has found something that’s scaring the living crap out of them, but they don’t really have a clue yet how to address it — and at the same time they don’t want to sound any alarms.

MichaelS

..and so, what about using the steam room at the gym? If this is spread by mucousal secretions, surely the warm steam would be a perfect breeding ground to keep the bacteria alive if a user were to sneeze or whatever…

dula

Still don’t get why this is focused on Gay men when the disease can be spread by coughing and sneezing near someone. Isn’t everybody at risk??

Straightnotnarrow

A fraction of people exposed fail to clear the bacteria but don’t get sick either. They carry the bacteria and by vaccinating, the goal is to boost immunity to clear the bacteria entirely and thereby limit occult spread (e.g. Typhoid Mary).

Mike_in_the_Tundra

Agreed. We should all seriously consider it. It seems like everyone is traveling a lot. Although I have not visited NYC for a long time, I have friends who have. I may not have had sex with these guys, but we kiss and hug when we greet one another. There is also the question of monogamy. Unless you and your significant other live all along on an island, there is a possibility that you’re not as monogamous as you think. Years ago, I had a friend who was monogamous. Unfortunately, his partner didn’t see things that way. My friend was tested and was positive. This happens in gay and straight relationships. i keep getting all sorts of vaccines. If my doctor thinks it’s a good idea, I’ll find the money to pay for the vaccines.

Straightnotnarrow

Yes. This organism lives in the mucous membranes of the nose and throat and is spread from contact with those secretions.

commenter

umm, that is, 2012…

commenter

Also, if “Symptoms may occur two to 10 days after exposure, but usually within five days”, why does the warning apply to visitors to NYC since Sept 1, 2010? Wouldn’t those individuals already be certain they didn’t contract the disease, if they didn’t have any symptoms?

Indigo

They’re confused, poor things. I think I’ll talk to my doctor on Tuesday when I go in for my physical to see what he thinks. The HPV vaccine is also recommended. The shingles vaccine is a good idea for seniors, too. There’s a lot going on around us in the medical vortex. We’re not getting a whole lot of clarity from the licensed authorities. [aside:Speaking of licensed authorities, the Titanic was built by degreed engineers with advanced skills but the ark was built by an old man with a drinking problem who had visions. Go figure.]

lamoose

so does this mean if one has gay male friends who visit or live in NYC, and kisses on them. and hugs them or shares a drink out of the same glass etc..we need to worry too?

SkippyFlipjack

If a lawyer doesn’t understand it doesn’t that suggest it was written clearly? :)

pappyvet

GET THE SHOT !!! The wingnuts will be short stroking this as God’s punishment all over the map

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